Fluoride Ineffective Topically And Systemically

Dr. Sauerheber challenges the oft stated concession, made even by those who oppose drinking water fluoridation, that fluoride prevents tooth decay when applied topically, as in the case of toothpaste at 1,500 ppm fluoride ion and varnishes at 12,000 ppm.

This is untrue, says Dr. Sauerheber. Fluoride is completely ineffective as a strengthener of tooth enamel. As soon as we drink something slightly acidic, any surface calcium fluoride simply washes off. We swallow all the toothpaste material we leave on our teeth. Toothpaste typically supplies a substantial percentage of the fluoride we ingest that enters the blood (NRC 2006, page 60). We should not be using fluoridated toothpaste. Fluoride toothpaste is a myth and a harmful one.

If saliva has a slightly acidic pH in the mouth, then fluoride can slow some bacterial growth, but it is hydrogen fluoride which does the killing, and at neutral pH, there is not very much hydrogen fluoride present. Conversely, at stomach pH of 3, half of the fluoride ions join with hydrogen to form hydrogen fluoride, which is electrically neutral and which can therefore slip through cell membranes to allow fluoride access to the bloodstream and from there to exert adverse effects.

Aside: The solubility product constant describes the equilibrium point where calcium fluoride, for example, goes from being dissolved in water to precipitating. If the concentration of fluoride ion is below the equilibrium point for calcium fluoride, it will not precipitate, that is fluoride ion will not react with or bond with calcium.

If fluoride ion is present in drinking water at 1 ppm, it will be present in the bloodstream at around 0.21 ppm, and in saliva at 0.02 ppm (NRC 2006 Report, pages 70-73). Dr. Sauerheber explains in his letter to the CDC, which appears below, that the concentration of fluoride ion in saliva is below the solubility product constant for the calcium level in saliva, and therefore it cannot form calcium fluoride in plaque or on teeth. When it comes to salivary fluoride ion, we just swallow it back down; experiments prove it cannot bind to crystalline calcium phosphate enamel at this low concentration.

The idea that fluoride ion in saliva at 0.02 ppm will bathe the teeth and somehow protect them by remineralizing them is poppycock. First, the enamel is glass-like, and fluoride ion just bounces off of it. Second, because the fluoride ion concentration is below the solubility product constant, fluoride at that low concentration cannot react with tooth surfaces, as it cannot even react with bone mineral, which is less crystalline.

On the other hand, the fluoride ion in toothpaste is much more concentrated, typically around 1,500 ppm, 75,000 times more concentrated than in saliva. In this case the concentration exceeds the solubility product constant and fluoride ion easily forms a weak ionic bond with the calcium present to form calcium fluoride globules. These globules dissolve as soon as we drink orange juice or anything slightly acidic, and thus we swallow all the toothpaste we do not spit out.

Dr. Sauerheber wrote the CDC on August 21, 2012, and asked about the 75,000 fold difference in concentration between fluoride ion in saliva and in toothpaste. He asked two questions: If fluoride ion at .02 ppm in saliva is effective to protect teeth, then why do we expose people to fluoride ion in toothpaste at 1,500 ppm? Conversely, if we believe that fluoride ion needs to be at 1,500 ppm to protect teeth, why would the CDC think that fluoride at 0.02 ppm would do anything at all to protect teeth? The CDC wrote back to say it could offer no explanation. The CDC said it would check with someone who might be able to answer the questions. The CDC has never responded and is at a complete loss for words.

Nevertheless, Dr. Sauerheber got his answer by thinking it through on his own: Fluoride is ineffective to penetrate or form a protective layer on teeth at both levels. Read his December 21, 2012, letter to the CDC below.

For the de-fluoridation movement as a whole, this raises an important point: We should come out openly and educate the public that fluoride is not effective at all, neither taken systemically nor applied topically. Fluoridated toothpaste, fluoridated mouthwash, fluoridated veneers — these are all myths. And they are harmful myths.

The de-fluoridation movement focuses on getting fluoridation chemicals out of drinking water, not on getting it out of toothpaste and mouthwash. The movement avoids criticizing topical fluoride, because some still believe it works topically, because people can choose to avoid it, because some of our allies (dentists who oppose fluoridated water but endorse topical applications), because it is a fight we do not have to fight, and to avoid making enemies we do not have to make.

This is a mistake. If we are to be believed, we should tell people the whole truth: Those who use fluoridated toothpaste in a city that uses 1 ppm fluoridated water can get up to half of their fluoride dose from their toothpaste. It does not bind permanently to tooth enamel, but it will penetrate gums and enter the dentin layer of the teeth, which is bone and thus more porous and which readily absorbs and binds with fluoride, making the interior of teeth brittle, causing what are referred to as “fluoride bombs”.

Fluoridated toothpaste and mouthwash are also hazardous products. The FDA recently reprimanded Walgreen’s for selling mouthwash with a label claiming fluoride ‘improves gum health’ when the evidence for the claim does not exist. Children love the flavor of toothpaste and sometimes lock themselves in the bathroom and eat fluoridated toothpaste, which may be how some people become hyper-sensitized to fluoride.

There is another reason why the de-fluoridation movement should oppose fluoridated toothpaste: The manufacturers of toothpaste are now trapped by the myth they helped create. Most people have come to believe the lie that fluoride in toothpaste helps their teeth. Almost all the toothpaste sold is fluoridated. Toothpaste manufacturers have tried to market non-fluoridated toothpaste, featuring the fact that it is okay for children to swallow it, but sales are low.

If toothpaste manufacturers are ever to stop selling fluoridated toothpaste, they would need a ruling from the FDA to help them do what they cannot themselves do.

The ruling should be that fluoridated toothpaste and fluoridated mouthwash should be available by prescription only for those who believe, after consulting with their physician, that it would serve a useful purpose.

We should tell people the whole truth about fluoridation: Avoid fluoride whether in drinking water, food, your shower, your toothpaste, or your mouthwash.

I asked Dr. Sauerheber if it is fair to say that fluoride applied topically offers absolutely no benefit. Dr. Sauerheber said:

The problem is that it is a half-truth that topically fluoride might be said to “work” in some peoples’ definition. For example, one might argue correctly that the fluoride in toothpaste forms calcium fluoride globules, that exist at least for a few hours on part of tooth surfaces before the next meal, which might help interfere with direct attack by bacterial acids for that brief time.

Another example: In the case of a person with very low body pH, topically applied fluoride would partially convert to hydrogen fluoride, which does kill bacteria, and in that sense it could be argued that fluoride “works”.

A final example: High topical fluoride in theory could exchange on the outer surface of enamel to about 0.1-0.2 microns of depth perhaps, and dentists would argue this is “remineralization” of enamel and thus that fluoridation “works”. But remember that enamel remains rock hard only when fluoride is kept out of it. If fluoride displaces the hydroxide in enamel, as it does in bone and in the dentin part of the tooth, such would be an abnormality and should not be held out as a normal or healthy mineralization.

I always say of course ingested fluoride from water does not work, either systemically or topically, and in fact cannot work because the ion remains soluble and is merely swallowed immediately and is not topically applied but is ingested and cannot precipitate or cause this abnormal ‘remineralization’.

For high level topical applications the situation is more complicated.

Dr. Richard Sauerheber

***

James says: I conclude from Dr. Sauerheber’s remarks that fluoride works topically but in ways which are limited and temporary and which cause collateral damage.

The equilibria that we have considered thus far have involved gases and acids and bases. Furthermore, they have been homogeneous, that is all the species have been in the same phase. We will now take up equilibria involving another important type of reaction: the dissolution or precipitation of ionic compounds. These reactions are heterogeneous. In our earlier discussion of precipitation reactions, we considered some general rules for predicting the solubility of common salts in water. These rules give us a qualitative sense of whether a compound will have a high or low solubility in water. By considering solubility equilibria we can make quantitative predictions about the amount of a given compound that will dissolve. We can also use these equilibria to analyze the factors that affect solubility.

A saturated solution of a slightly soluble salt in contact with undissolved salt involves an equilibrium like the one below.

CaF2(s) <==> Ca2+(aq) + 2 F–(aq)

In writing the equilibrium constant expression for a heterogeneous equilibria, we ignore the concentrations of pure liquids and solids. So the equilibrium constant expression for the equilibria above is:

Ksp = [Ca2+][F–]2

This equilibrium constant is called a solubility-product constant. Even though [CaF2] is excluded from the equilibrium constant expression, some undissolved CaF2(s) must be present in order for the system to be at equilibrium. In general, the solubility product constant (Ksp) is the equilibrium constant for the equilibrium that exists between a solid ionic solute and its ions in a saturated aqueous solution. The rules for writing the solubility-product expression are the same as those for writing any other equilibrium constant expression: The solubility product is equal to the product of the concentrations of the ions involved in the equilibrium, each raised to the power of its coefficient in the equilibrium equation.

Solubility and Ksp

It is important to distinguish carefully between solubility and solubility product. The solubility of a substance is the quantity that dissolves to form a saturated solution. Solubility is often expressed as grams of solute per liter of solution. The molar solubility is the number of moles of the solute that dissolve in forming a liter of saturated solution of the solute. The solubility product constant is the equilibrium constant for the equilibrium between an ionic solid and its saturated solution. The solubility of a substance changes as the concentration of other solutes change. In contrast, the solubility product for a given solute in water is constant at a specific temperature.

In studying solubility equilibria, it is important to be able to interconvert solubility and solubility product. The following examples will illustrate this.

Example 1

The Ksp for CaF2 is 3.9 x 10-11 at 25oC. What is the (a) molar solubility of CaF2 in water? (b) What is the solubility in grams per liter?

First set up an equilibrium table and let x = [Ca2+] (and the molar solubility of CaF2 )

Concentrations(M)

CaF2(s)

<==>

Ca2+(aq)

+

2 F–(aq)

Starting

0

0

Change

+x

+2x

Equilibrium

x

2x

Ksp = [Ca2+][F–]2 = (x)(2x)2 = 4x3 = 3.9 x 10-11

(a) x = (3.9 x 10-11 /4)1/3 = 2.1 x 10-4 M

(b) Convert moles per liter of CaF2 to grams per liter.

2.1 x 10-4 mol CaF2 78.1 g CaF2

——————- x ———— = 1.6 x 10-2 g CaF2 /L soln

1 L soln 1 mol CaF2

Example 2

Analysis of a saturated solution of silver chromate, Ag2CrO4, indicates that the concentration of silver ion is 1.3 x 10-4 M. What is the Ksp of Ag2CrO4?

The equilibrium equation and the solubility product expression are:

Ag2CrO4(s) <==> 2 Ag+(aq) + CrO42- Ksp = [Ag+]2[CrO4]

From the equation we can see that at equilibrium, the concentration of CrO42- is going to be half that of Ag+.

Many months ago I asked a very simple question regarding the discrepancy between fluoride concentrations in toothpaste at 1500 ppm that are 75,000 times higher than fluoride in saliva after ingestion of fluoridated drinking water at 0.02 ppm. I was told CDC would send the inquiry to someone to try to find an answer. No answer has been presented to date, but the answer has now become clear. It is necessary for the CDC to understand this, as described in detail below, because today the CDC is the nation’s chief promoter and facilitator of industrial fluoride infusions into public water supplies to treat humans even though the U.S. Safe Drinking Water Act prohibits any Federal agency from establishing a concentration for any substance in water other than required to sanitize the water.

Please examine the following referenced information to help you understand the significance of the current position of the CDC on water fluoridation that is improperly and incompletely described on the CDC fluoridation website as being a public health achievement, without explanation of 1) what concentration of fluoride is involved in the claim, 2) the specific mechanism by which the claim occurs, and 3) why all side effects from lifelong ingestion of industrial ionic fluorides by everyone, even the infirmed, are allowed by the CDC. Taken together the data indicate that industrial fluoride ingestion is ineffective, harmful and expensive in its stated purpose as claimed.

Fluoride Precipitation Calculations. The solubility product constant Ksp for calcium fluoride CaF2 is Ksp = 3.3 x 10-11, where Ksp = [Ca 2+][F–]2. At 0.02 ppm ( 3.8 x 10-4 M) fluoride in saliva, which contains typically a calcium level of 1 x 10-4 M, the precipitation reaction quotient value, Qsp = 1.1 x 10-11, is less than the Ksp. So it is not possible for fluoride to precipitate calcium fluoride from saliva by the fluoride ingested from drinking water. Instead, saliva fluoride is simply swallowed as the free ion. On the other hand, 1,500 ppm fluoride (0.079 M) in toothpaste applied to teeth readily forms calcium fluoride globules on teeth surfaces since the reaction quotient, Qsp = 1.1 x 10-8, is far in excess of the Ksp. These globules have been identified by electron microscopy on teeth surfaces that do not penetrate into enamel interiors, and are readily dissolved after eating a typical meal or beverage since calcium fluoride readily dissolves in slightly acidic conditions.

Origin of Ingested Fluoride and Caries Beliefs. Ingested calcium, not ingested fluoride, can build strong teeth. The statistical analysis of extensive data sets by Ziegelbecker as reviewed in Connett [Connett, P., Micklem, H. and Beck, J., The Case Against Fluoride, Chelsea Green Publishing, White River Junction, VT, 2010] eliminated the accidental tendency to ‘cherry pick’ data in favor of a particular bias and confirms that fluoride in drinking water has nothing to do with incidence of tooth decay. Consistent with these observations, the original theory that water fluoride correlated with teeth health in Hereford, Texas, the storied ‘town without a tooth ache’, failed to include the fact that high levels of calcium and magnesium totaling 203 ppm accompany the fluoride [Ericksson, A. W., Field Notes Crop Reporting Service, Minneapolis, MN, 1945]. Although consumption of water with 1 ppm fluoride causes 0.21 ppm average levels in blood [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006] (which can harm teeth by commonly forming abnormal permanent teeth enamel fluorosis, as well as other adverse pathology), the U.S. CDC has published that systemic fluoride from the bloodstream after consumption from water does not reduce dental caries.

CDC presently argues then that fluoride must benefit teeth through a surface, direct topical mechanism, continuing the belief that fluoridation is a ‘great public health achievement’. However, biochemical measurements confirm the fact that ingested fluoride likewise cannot topically affect formed teeth structure — since ingested fluoride from 1 ppm water reaches an average of only 0.02 ppm in saliva [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006.], a concentration that is useless in affecting teeth topically. Furthermore, even at extremely high fluoride levels of 1,500 in pastes (75,000 times higher than ingested fluoride from water into saliva) or 10-12,000 ppm in gels and varnishes (600,000 times higher than in saliva), fluoride is unable to penetrate into the matrix of crystalline, rock-hard normal teeth enamel [Türkiye, S. Ölmez, B. Yuksel, H. Çelik, Department of Pedodontics, Faculty of Dentistry, Hacettepe University, Ankara, Scanning Electron Microscope Study of Human Enamel Surfaces Treated with Topical Fluoride Agents, J. Islamic Academy of Sciences 6(2), p. 133, 1993].

The phenomenon known as ‘remineralization’ appears to be in large part the simple formation of calcium fluoride globules on tooth surfaces [8], which are readily soluble in foods/beverages having slight acidity, and small amounts of surface fluoride exchange. Finally, research animal studies, where confounding variables are fully controlled, proved that 1 ppm fluoride water does not decrease incidence of spontaneous dental decay in mammals (Yiamouyiannis, J., Fluoride the Aging Factor, 1963).

Original Trials with Industrial Fluoride. The reliance, by those who promote the ingestion of diluted industrial fluorides, on data collected from innocent citizens in the city of Newburgh, N.Y. is particularly appalling. At a time of American jubilance for the U.S. military in finishing WWII, this entire city public water supply was treated with industrial synthetic sodium fluoride without obtaining permission from consumers for human experimentation. The twisted rationale for these experiments has been amply described recently [Bryson, C., The Fluoride Deception, Seven Stories Press, N.Y., 2004.]. In spite of many variables being un-controlled because the subjects were not volunteers who regulated their diet, etc., expert statisticians were able to demonstrate later that delayed teeth eruption occurred in children compared to the control city of Kingston and that exuberant officials falsely interpreted this as ‘prevention’ of caries. Other adverse biologic sequelae, summarized by several reviewers [Connett, P., Micklem, H. and Beck, J., The Case Against Fluoride, How Hazardous Waste ended up in our Water Supply and the Politics that Keep it There, Chelsea Green Publishing, White River Junction, VT, 2010] were downplayed as ‘minimal’. Experiments with human volunteers who agree to regulate diet and other variables, to study long term safety of ingested synthetic fluorides as required by the Food Drug & Cosmetic Act for any substance to be ingested to treat humans in the U.S., have never been published.

Toothpaste Follows Suit. Toothpaste manufacturers picked up the belief that fluoride somehow decreases caries and began adding it into toothpaste as stannous fluoride, then mono fluoro phosphate and now most widely as sodium fluoride. But since caries still existed after both water fluoridation and toothpaste fluoride use, the amount of fluoride in toothpaste gradually was increased until presently it is 75,000 times more concentrated than in treated water supplies. Since toothpaste is not designed to be swallowed the high concentrations can contribute as much as 50% of the total amount of fluoride in the bloodstream for those also consuming fluoridated water, depending on its calcium content. Fluoride applied topically as an ion the size of a water molecule penetrates gum tissue.

Fluoride and Adverse Teeth Health. All industrial ionic fluoride compounds lack calcium and are toxic calcium chelators. Teeth are harmed during chronic exposure to fluoride in at last five different ways.

1) Fluoride incorporates into dentin which is a derivative of bone, but a tissue that does not have turnover. Fluoride is thus permanent in dentin lifetime and, just as fluoride weakens bone, dentin is less resistant to cracking and fluoride in dentin is associated with teeth loss. The highest rate of teeth loss in the U.S. is in the state of Kentucky, the most completely fluoridated state in the U.S. The lowest incidence of teeth loss is in non-fluoridated Hawaii. The highest incidence of teeth loss in Europe is in silicofluoridated Southern Ireland. Fluoride can incorporate into dentin, either from that ingested into the bloodstream from water or pastes, or directly by passage through gum tissue from toothpaste topical use.

2) Fluoride from either the blood after ingestion, or from toothpaste applications, during enamelization of teeth in children can cause tooth fluorosis, where abnormal enamel hypoplasia occurs as a result of fluoride inhibition of enzymes necessary to remove albumin while minerals are deposited. The result is white spots of trapped albumin in the enamel where it does not belong and an ugly tooth. In some cases gross deterioration of the tooth can occur. If we examine pictures of victims of tooth fluorosis, caused by blood fluoride after ingesting fluoridated water during infancy, there can be destroyed areas of teeth, and even in more mild cases fluorosis is a permanent abnormality [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006] that prevents a healthy normal smile [www.spotsonmyteeth.com (the Lillie Center].

The U.S. Oral Health Division. The CDC finally disputes that systemic fluoride fights teeth decay, but nevertheless puzzlingly still promotes fluoridation of water as a method to fight caries [U.S. CDC in: MMWR, Morbidity and Mortality Weekly Report, August 17,2001]. The argument has long been made that the teeth structure that remains in fluorotic victims is more resistant to decay because the hydroxyapatite normal enamel has been converted into an altered form [Newbrun, E., Fluorides and Dental Caries, Thomas Books, Springfield, ILL, 1972], but fluoride does not penetrate the enamel significantly, rather the ion can prevent the removal of albumin while teeth are depositing enamel during development, leading to loss of the translucent glass-like normal structure. Furthermore, locations where fluorotic teeth have worn away do not have cavities, because there is no teeth structure there. This bizarre argument was used to rationalize the lack of effect on decay rate in fluoridated Newburgh, where teeth erupted one year late due to systemic fluoride ingestion in the treated city [Connett, P., Micklem, Beck, The Case Against Fluoride, Chelsea Green Publishing, White River Junction, VT, 2011]. Decay rates were identical for both cities’ children after teeth grew into the mouth.

In other words, let’s consider that indeed fluoride in this severely fluorotic victim shown here has done its job in decreasing incidence of tooth decay (by virtue of spaces with no teeth regions that could contain cavities, and that remaining teeth surfaces have become ‘resistant’). The fact that teeth portions are ruined in a subset of the population from total fluoride exposure for all sources during development is considered of lesser importance because fluoride infusions into public water supplies are continued even though the incidence of dental fluorosis increases in all treated cities without exception. The fact that decay rates in teeth after growing into the mouth were identical in Newburgh is also not addressed in the OHD analysis.

3) Fluoride applied to teeth topically is sufficient of cause precipitation of calcium fluoride globules on the surface of teeth enamel. These are irregular porous globs that fill in pockets in enamel that are not smooth. Although some may argue this shields the tooth from caries, calcium fluoride is mostly and readily dissolved upon eating foods, and any trapped in teeth fissures for longer periods would be involved in beginning the formation of tartar. Tartar can trap bacteria unnaturally that cause caries, and does not preventing caries.

4) Small amounts of fluoride are argued to incorporate into surface enamel layers, a process called ‘remineralization’ of teeth. However, natural remineralization of enamel surfaces is known to occur with calcium and phosphate. Fluoride interferes with normal remineralization by producing an abnormal enamel surface. Enamel is normally extremely hard and fluoride cannot penetrate into the matrix of the enamel fortunately. Fluoride has been reported to be found in only the outer 2 micron layer (NRC, 2006, p.70).

5) In the case of fluoridation with fluorosilicic acid, an additional mechanism by which teeth are harmed over longterm exposure is by direct degradation. Fluorosilicic acid dissociates into fluoride ion and silicic acid in approximately equal amounts in trated water supplies. At neutral pH, the silicic acid as a very weak acid, is the intact molecule. At 0.6 ppm in water adjusted to 0.7 ppm fluoride, silicic acid explains well the leeching of lead from lead based plumbing in treated water supplies, and in agriculture silicic acid is a known disruptor of calcium phosphate, releasing free phosphate in soils for better uptake by plants. Drinking silicofluoridated water exposes calcium phosphate teeth enamel to the intact silicic acid at concentrations comparable to that for fluoride in the water. Longterm degradation cannot be avoided in the presence of this acid, much like it is known that enamel can be dissolved in carbonic acid in soda over long time periods.

Proper Teeth Care. It must be emphasized to those who hold the view, that ‘fluoridation is a great public health achievement’, that people who desire fewer teeth caries also prefer to retain their teeth, and to have a healthy normal smile, and to have normal translucent glasslike teeth enamel while cavities are being fought. Teeth decay can be fought by brushing after eating sugar, or avoiding sugar, and treatment of gums to inhibit cavity-causing Streptococcus mutans with regular teeth cleaning or now with laser therapy when necessary.

Fluoride in saliva at 0.02 ppm or in water at 0.7 ppm cannot penetrate teeth enamel with significance, nor decrease bacterial growth [Meiers, P., Fluoride and Dental Caries: Second Thoughts in View of Recent Evidence from Germany, Fluoride 44(1) pp. 1-6, 2011]. This is consistent with the lack of incorporation of fluoride into teeth enamel interiors when treated with 12,000 ppm fluoride, proven by detailed electron microscopic examination [Türkiye, et.al., 1993]. Toothpaste contains 1,500 ppm fluoride, a level that does not slow bacterial growth unless the medium were acidic, where sufficient corrosive HF could form.

CDC Unable to Explain Discrepancy. It has now been six months since asking the CDC to clarify why fluoride in saliva that bathes teeth topically at 0.02 ppm is 75,000 times less concentrated than in toothpaste (letter to FDA dated August 21, 2012). The CDC after two months responded that they have no answer to the inquiry and would send it to others to try to find an answer. No answer has been provided to date and I have been advised by legal counsel that it is therefore legal and proper to conclude that the CDC, in not providing a timely answer, does not have an answer. The Oral Health Division of the CDC has no legal right to authorize the infusion of industrial fluoride compounds into public water supplies at this useless concentration. Hence the FDA has been asked on behalf of the citizens of these United States to ban the practice of adding industrial fluorides into public water supplies to treat people for dental caries, when it has not been FDA approved for this purpose. The 1966 ban on fluorides intended for oral ingestion in pregnant women was ordered because of no evidence of effectiveness, and the requested ban on fluorides to be infused into water supplies to treat people is also for this same reason.

Fluoride Lack of Effect on Caries. Differences in the consumption of caries-causing sugar were not examined in the original anecdotal studies claiming caries benefit from ingested fluoride water that began this whole belief system that infusing industrial fluorides into water systems was necessary to ‘fortify’ water. The false hope that systemic fluoride ingested from water would affect enamel caries fell by the wayside when biochemical proof demonstrated that 1) systemic fluoride accumulates into dentin interiors of teeth (average 394 ppm from 1 ppm treated water) (National Research Council, Report on Fluoride in Drinking Water, 2006, p. 73) that enamel exists to protect (p. 126), and 2) fluoride in the bloodstream from consumed water, treated with industrial fluoride without FDA approval, causes, without exception in any treated city, increased incidence of inefficient enamel formation during teeth development, where ugly enamel fluorosis has reached endemic incidence in U.S. teens (http://www.cdc.gov/nchs/data/databriefs/db53.pdf). The U.S. Health and Human Services requested fluoride treatment of water supplies be reduced for merely this reason alone, and an official decision to ban the infusions is now necessary for the U.S. population, as was properly done in 1966 by the FDA for pregnant women.

Recent studies confirmed the concerns published by the National Research Council (2006, p. 126) regarding fluoridated dentin fracture and tooth loss (Offenbacher, et.al., Journal of Periodontal Research 27, p. 207, 1992). Because gum tissue and dentin incorporate fluoride both from toothpaste and from ingested water systemically, tooth loss and periodontitis are widely prevalent in the U.S. The state of Kentucky was presented an award by the American Dental Association for its mandatory fluoridation of virtually all public water supplies in the state for 50 years

(http://www.skagitcleanwater.com/Fluoridation_concern_%20Brief_%200utline.pdf). But no mention was made of the fact that tooth caries incidence in Kentucky is not lower than that in any other state (personal communication, Dr. Bill Osmunsen) and that the U.S. CDC published that Kentucky leads the nation in tooth loss at a massive 42% (Public Health and Aging: Retention of Natural Teeth Among Older Adults United States, 2002, Centers for Disease Control). There is no life-long reduction in dental decay that can be directly attributable to water fluoridation, and instead there appears to be an increase in tooth loss associated with fluoridation amongst the older population who have the longest exposure compared to non fluoridated communities (personal communication, Declan Waugh, Environmental Scientist, Ireland). The CDC report findings support this in noting:“The prevalence of edentate persons (i.e., those who have lost all their natural teeth) ranged from 13% in Hawaii to 42% in Kentucky.” The lowest rates of tooth loss in people over 60 years of age occur in the states with the lowest rates of water fluoridation. It is irrational to defend the idea that this is a coincidence, in light of the propensity of fluoride to concentrate into dentin as in skeletal bone, weakening bone.

U.S. Food and Drug Administration. The FDA ruled that fluoride is not a mineral nutrient and addition into water is an uncontrolled use of an unapproved drug. Further, the FDA in 1966 went so far as to ban the sale of industrial fluoride to infuse into drinking water intended to be ingested by pregnant women in the U.S. This ban was instituted because of proof that ingested fluoride by the mother does not decrease dental decay in the newborn after such exposure. Taking a drug that has no benefit is unethical, since all drugs, including fluoride, have adverse side effects.

On the other hand, FDA approved the use of fluoride in topical toothpastes but all are required to display the warning, “not to be swallowed or used by children under six.” Further, FDA approved the sale of bottled water if it happened to already contain fluoride as long as it is less or equal to 1 ppm and was not intentionally added into the water. Labeling of bottled waters for fluoride content were not permitted because FDA views fluoride as not being a normal or necessary ingredient in drinking water. Petitions have been filed with the FDA and accepted for review and remain pending, requesting that 1) all fluoride containing materials taken orally shall require a prescription, and 2) all industrial fluoride infusions into U.S. public water supplies be halted, as originally intended in the U.S.Water Pollution Control Act and the U.S. Safe Drinking Water Act (FDA-2007-P-0346).

Intro by James Robert Deal,
Followed by article by Dr. Richard Sauerheber

Dr. Sauerheber challenges the oft stated concession, made even by those who oppose drinking water fluoridation, that fluoride prevents tooth decay when applied topically, as in the case of toothpaste at 1,500 ppm fluoride ion and varnishes at 12,000 ppm.

This is untrue, says Dr. Sauerheber. Fluoride is completely ineffective as a strengthener of tooth enamel. As soon as we drink something slightly acidic, any surface calcium fluoride simply washes off. We swallow all the toothpaste material we leave on our teeth. Toothpaste typically supplies a substantial percentage of the fluoride we ingest that enters the blood (NRC 2006, page 60). We should not be using fluoridated toothpaste. Fluoride toothpaste is a myth and a harmful one.

If saliva has a slightly acidic pH in the mouth, then fluoride can slow some bacterial growth, but it is hydrogen fluoride which does the killing, and at neutral pH, there is not very much hydrogen fluoride present. Conversely, at stomach pH of 3, half of the fluoride ions join with hydrogen to form hydrogen fluoride, which is electrically neutral and which can therefore slip through cell membranes to allow fluoride access to the bloodstream and from there to exert adverse effects.

Aside: The solubility product constant describes the equilibrium point where calcium fluoride, for example, goes from being dissolved in water to precipitating. If the concentration of fluoride ion is below the equilibrium point for calcium fluoride, it will not precipitate, that is fluoride ion will not react with or bond with calcium.

If fluoride ion is present in drinking water at 1 ppm, it will be present in the bloodstream at around 0.21 ppm, and in saliva at 0.02 ppm (NRC 2006 Report, pages 70-73). Dr. Sauerheber explains in his letter to the CDC, which appears below, that the concentration of fluoride ion in saliva is below the solubility product constant for the calcium level in saliva, and therefore it cannot form calcium fluoride in plaque or on teeth. When it comes to salivary fluoride ion, we just swallow it back down; experiments prove it cannot bind to crystalline calcium phosphate enamel at this low concentration.

The idea that fluoride ion in saliva at 0.02 ppm will bathe the teeth and somehow protect them by remineralizing them is poppycock. First, the enamel is glass-like, and fluoride ion just bounces off of it. Second, because the fluoride ion concentration is below the solubility product constant, fluoride at that low concentration cannot react with tooth surfaces, as it cannot even react with bone mineral, which is less crystalline.

On the other hand, the fluoride ion in toothpaste is much more concentrated, typically around 1,500 ppm, 75,000 times more concentrated than in saliva. In this case the concentration exceeds the solubility product constant and fluoride ion easily forms a weak ionic bond with the calcium present to form calcium fluoride globules. These globules dissolve as soon as we drink orange juice or anything slightly acidic, and thus we swallow all the toothpaste we do not spit out.

Dr. Sauerheber wrote the CDC on August 21, 2012, and asked about the 75,000 fold difference in concentration between fluoride ion in saliva and in toothpaste. He asked two questions: If fluoride ion at .02 ppm in saliva is effective to protect teeth, then why do we expose people to fluoride ion in toothpaste at 1,500 ppm? Conversely, if we believe that fluoride ion needs to be at 1,500 ppm to protect teeth, why would the CDC think that fluoride at 0.02 ppm would do anything at all to protect teeth? The CDC wrote back to say it could offer no explanation. The CDC said it would check with someone who might be able to answer the questions. The CDC has never responded and is at a complete loss for words.

Nevertheless, Dr. Sauerheber got his answer by thinking it through on his own: Fluoride is ineffective to penetrate or form a protective layer on teeth at both levels. Read his December 21, 2012, letter to the CDC below.

For the de-fluoridation movement as a whole, this raises an important point: We should come out openly and educate the public that fluoride is not effective at all, neither taken systemically nor applied topically. Fluoridated toothpaste, fluoridated mouthwash, fluoridated veneers — these are all myths. And they are harmful myths.

The de-fluoridation movement focuses on getting fluoridation chemicals out of drinking water, not on getting it out of toothpaste and mouthwash. The movement avoids criticizing topical fluoride, because some still believe it works topically, because people can choose to avoid it, because some of our allies (dentists who oppose fluoridated water but endorse topical applications), because it is a fight we do not have to fight, and to avoid making enemies we do not have to make.

This is a mistake. If we are to be believed, we should tell people the whole truth: Those who use fluoridated toothpaste in a city that uses 1 ppm fluoridated water can get up to half of their fluoride dose from their toothpaste. It does not bind permanently to tooth enamel, but it will penetrate gums and enter the dentin layer of the teeth, which is bone and thus more porous and which readily absorbs and binds with fluoride, making the interior of teeth brittle, causing what are referred to as “fluoride bombs”.

Fluoridated toothpaste and mouthwash are also hazardous products. The FDA recently reprimanded Walgreen’s for selling mouthwash with a label claiming fluoride ‘improves gum health’ when the evidence for the claim does not exist. Children love the flavor of toothpaste and sometimes lock themselves in the bathroom and eat fluoridated toothpaste, which may be how some people become hyper-sensitized to fluoride.

There is another reason why the de-fluoridation movement should oppose fluoridated toothpaste: The manufacturers of toothpaste are now trapped by the myth they helped create. Most people have come to believe the lie that fluoride in toothpaste helps their teeth. Almost all the toothpaste sold is fluoridated. Toothpaste manufacturers have tried to market non-fluoridated toothpaste, featuring the fact that it is okay for children to swallow it, but sales are low.

If toothpaste manufacturers are ever to stop selling fluoridated toothpaste, they would need a ruling from the FDA to help them do what they cannot themselves do.

The ruling should be that fluoridated toothpaste and fluoridated mouthwash should be available by prescription only for those who believe, after consulting with their physician, that it would serve a useful purpose.

We should tell people the whole truth about fluoridation: Avoid fluoride whether in drinking water, food, your shower, your toothpaste, or your mouthwash.

I asked Dr. Sauerheber if it is fair to say that fluoride applied topically offers absolutely no benefit. Dr. Sauerheber said:

The problem is that it is a half-truth that topically fluoride might be said to “work” in some peoples’ definition. For example, one might argue correctly that the fluoride in toothpaste forms calcium fluoride globules, that exist at least for a few hours on part of tooth surfaces before the next meal, which might help interfere with direct attack by bacterial acids for that brief time.

Another example: In the case of a person with very low body pH, topically applied fluoride would partially convert to hydrogen fluoride, which does kill bacteria, and in that sense it could be argued that fluoride “works”.

A final example: High topical fluoride in theory could exchange on the outer surface of enamel to about 0.1-0.2 microns of depth perhaps, and dentists would argue this is “remineralization” of enamel and thus that fluoridation “works”. But remember that enamel remains rock hard only when fluoride is kept out of it. If fluoride displaces the hydroxide in enamel, as it does in bone and in the dentin part of the tooth, such would be an abnormality and should not be held out as a normal or healthy mineralization.

I always say of course ingested fluoride from water does not work, either systemically or topically, and in fact cannot work because the ion remains soluble and is merely swallowed immediately and is not topically applied but is ingested and cannot precipitate or cause this abnormal ‘remineralization’.

For high level topical applications the situation is more complicated.

Dr. Richard Sauerheber

***

James says: I conclude from Dr. Sauerheber’s remarks that fluoride works topically but in ways which are limited and temporary and which cause collateral damage.

The equilibria that we have considered thus far have involved gases and acids and bases. Furthermore, they have been homogeneous, that is all the species have been in the same phase. We will now take up equilibria involving another important type of reaction: the dissolution or precipitation of ionic compounds. These reactions are heterogeneous. In our earlier discussion of precipitation reactions, we considered some general rules for predicting the solubility of common salts in water. These rules give us a qualitative sense of whether a compound will have a high or low solubility in water. By considering solubility equilibria we can make quantitative predictions about the amount of a given compound that will dissolve. We can also use these equilibria to analyze the factors that affect solubility.

A saturated solution of a slightly soluble salt in contact with undissolved salt involves an equilibrium like the one below.

CaF2(s) <==> Ca2+(aq) + 2 F–(aq)

In writing the equilibrium constant expression for a heterogeneous equilibria, we ignore the concentrations of pure liquids and solids. So the equilibrium constant expression for the equilibria above is:

Ksp = [Ca2+][F–]2

This equilibrium constant is called a solubility-product constant. Even though [CaF2] is excluded from the equilibrium constant expression, some undissolved CaF2(s) must be present in order for the system to be at equilibrium. In general, the solubility product constant (Ksp) is the equilibrium constant for the equilibrium that exists between a solid ionic solute and its ions in a saturated aqueous solution. The rules for writing the solubility-product expression are the same as those for writing any other equilibrium constant expression: The solubility product is equal to the product of the concentrations of the ions involved in the equilibrium, each raised to the power of its coefficient in the equilibrium equation.

Solubility and Ksp

It is important to distinguish carefully between solubility and solubility product. The solubility of a substance is the quantity that dissolves to form a saturated solution. Solubility is often expressed as grams of solute per liter of solution. The molar solubility is the number of moles of the solute that dissolve in forming a liter of saturated solution of the solute. The solubility product constant is the equilibrium constant for the equilibrium between an ionic solid and its saturated solution. The solubility of a substance changes as the concentration of other solutes change. In contrast, the solubility product for a given solute in water is constant at a specific temperature.

In studying solubility equilibria, it is important to be able to interconvert solubility and solubility product. The following examples will illustrate this.

Example 1

The Ksp for CaF2 is 3.9 x 10-11 at 25oC. What is the (a) molar solubility of CaF2 in water? (b) What is the solubility in grams per liter?

First set up an equilibrium table and let x = [Ca2+] (and the molar solubility of CaF2 )

Concentrations(M)

CaF2(s)

<==>

Ca2+(aq)

+

2 F–(aq)

Starting

0

0

Change

+x

+2x

Equilibrium

x

2x

Ksp = [Ca2+][F–]2 = (x)(2x)2 = 4x3 = 3.9 x 10-11

(a) x = (3.9 x 10-11 /4)1/3 = 2.1 x 10-4 M

(b) Convert moles per liter of CaF2 to grams per liter.

2.1 x 10-4 mol CaF2 78.1 g CaF2

——————- x ———— = 1.6 x 10-2 g CaF2 /L soln

1 L soln 1 mol CaF2

Example 2

Analysis of a saturated solution of silver chromate, Ag2CrO4, indicates that the concentration of silver ion is 1.3 x 10-4 M. What is the Ksp of Ag2CrO4?

The equilibrium equation and the solubility product expression are:

Ag2CrO4(s) <==> 2 Ag+(aq) + CrO42- Ksp = [Ag+]2[CrO4]

From the equation we can see that at equilibrium, the concentration of CrO42- is going to be half that of Ag+.

Many months ago I asked a very simple question regarding the discrepancy between fluoride concentrations in toothpaste at 1500 ppm that are 75,000 times higher than fluoride in saliva after ingestion of fluoridated drinking water at 0.02 ppm. I was told CDC would send the inquiry to someone to try to find an answer. No answer has been presented to date, but the answer has now become clear. It is necessary for the CDC to understand this, as described in detail below, because today the CDC is the nation’s chief promoter and facilitator of industrial fluoride infusions into public water supplies to treat humans even though the U.S. Safe Drinking Water Act prohibits any Federal agency from establishing a concentration for any substance in water other than required to sanitize the water.

Please examine the following referenced information to help you understand the significance of the current position of the CDC on water fluoridation that is improperly and incompletely described on the CDC fluoridation website as being a public health achievement, without explanation of 1) what concentration of fluoride is involved in the claim, 2) the specific mechanism by which the claim occurs, and 3) why all side effects from lifelong ingestion of industrial ionic fluorides by everyone, even the infirmed, are allowed by the CDC. Taken together the data indicate that industrial fluoride ingestion is ineffective, harmful and expensive in its stated purpose as claimed.

Fluoride Precipitation Calculations. The solubility product constant Ksp for calcium fluoride CaF2 is Ksp = 3.3 x 10-11, where Ksp = [Ca 2+][F–]2. At 0.02 ppm ( 3.8 x 10-4 M) fluoride in saliva, which contains typically a calcium level of 1 x 10-4 M, the precipitation reaction quotient value, Qsp = 1.1 x 10-11, is less than the Ksp. So it is not possible for fluoride to precipitate calcium fluoride from saliva by the fluoride ingested from drinking water. Instead, saliva fluoride is simply swallowed as the free ion. On the other hand, 1,500 ppm fluoride (0.079 M) in toothpaste applied to teeth readily forms calcium fluoride globules on teeth surfaces since the reaction quotient, Qsp = 1.1 x 10-8, is far in excess of the Ksp. These globules have been identified by electron microscopy on teeth surfaces that do not penetrate into enamel interiors, and are readily dissolved after eating a typical meal or beverage since calcium fluoride readily dissolves in slightly acidic conditions.

Origin of Ingested Fluoride and Caries Beliefs. Ingested calcium, not ingested fluoride, can build strong teeth. The statistical analysis of extensive data sets by Ziegelbecker as reviewed in Connett [Connett, P., Micklem, H. and Beck, J., The Case Against Fluoride, Chelsea Green Publishing, White River Junction, VT, 2010] eliminated the accidental tendency to ‘cherry pick’ data in favor of a particular bias and confirms that fluoride in drinking water has nothing to do with incidence of tooth decay. Consistent with these observations, the original theory that water fluoride correlated with teeth health in Hereford, Texas, the storied ‘town without a tooth ache’, failed to include the fact that high levels of calcium and magnesium totaling 203 ppm accompany the fluoride [Ericksson, A. W., Field Notes Crop Reporting Service, Minneapolis, MN, 1945]. Although consumption of water with 1 ppm fluoride causes 0.21 ppm average levels in blood [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006] (which can harm teeth by commonly forming abnormal permanent teeth enamel fluorosis, as well as other adverse pathology), the U.S. CDC has published that systemic fluoride from the bloodstream after consumption from water does not reduce dental caries.

CDC presently argues then that fluoride must benefit teeth through a surface, direct topical mechanism, continuing the belief that fluoridation is a ‘great public health achievement’. However, biochemical measurements confirm the fact that ingested fluoride likewise cannot topically affect formed teeth structure — since ingested fluoride from 1 ppm water reaches an average of only 0.02 ppm in saliva [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006.], a concentration that is useless in affecting teeth topically. Furthermore, even at extremely high fluoride levels of 1,500 in pastes (75,000 times higher than ingested fluoride from water into saliva) or 10-12,000 ppm in gels and varnishes (600,000 times higher than in saliva), fluoride is unable to penetrate into the matrix of crystalline, rock-hard normal teeth enamel [Türkiye, S. Ölmez, B. Yuksel, H. Çelik, Department of Pedodontics, Faculty of Dentistry, Hacettepe University, Ankara, Scanning Electron Microscope Study of Human Enamel Surfaces Treated with Topical Fluoride Agents, J. Islamic Academy of Sciences 6(2), p. 133, 1993].

The phenomenon known as ‘remineralization’ appears to be in large part the simple formation of calcium fluoride globules on tooth surfaces [8], which are readily soluble in foods/beverages having slight acidity, and small amounts of surface fluoride exchange. Finally, research animal studies, where confounding variables are fully controlled, proved that 1 ppm fluoride water does not decrease incidence of spontaneous dental decay in mammals (Yiamouyiannis, J., Fluoride the Aging Factor, 1963).

Original Trials with Industrial Fluoride. The reliance, by those who promote the ingestion of diluted industrial fluorides, on data collected from innocent citizens in the city of Newburgh, N.Y. is particularly appalling. At a time of American jubilance for the U.S. military in finishing WWII, this entire city public water supply was treated with industrial synthetic sodium fluoride without obtaining permission from consumers for human experimentation. The twisted rationale for these experiments has been amply described recently [Bryson, C., The Fluoride Deception, Seven Stories Press, N.Y., 2004.]. In spite of many variables being un-controlled because the subjects were not volunteers who regulated their diet, etc., expert statisticians were able to demonstrate later that delayed teeth eruption occurred in children compared to the control city of Kingston and that exuberant officials falsely interpreted this as ‘prevention’ of caries. Other adverse biologic sequelae, summarized by several reviewers [Connett, P., Micklem, H. and Beck, J., The Case Against Fluoride, How Hazardous Waste ended up in our Water Supply and the Politics that Keep it There, Chelsea Green Publishing, White River Junction, VT, 2010] were downplayed as ‘minimal’. Experiments with human volunteers who agree to regulate diet and other variables, to study long term safety of ingested synthetic fluorides as required by the Food Drug & Cosmetic Act for any substance to be ingested to treat humans in the U.S., have never been published.

Toothpaste Follows Suit. Toothpaste manufacturers picked up the belief that fluoride somehow decreases caries and began adding it into toothpaste as stannous fluoride, then mono fluoro phosphate and now most widely as sodium fluoride. But since caries still existed after both water fluoridation and toothpaste fluoride use, the amount of fluoride in toothpaste gradually was increased until presently it is 75,000 times more concentrated than in treated water supplies. Since toothpaste is not designed to be swallowed the high concentrations can contribute as much as 50% of the total amount of fluoride in the bloodstream for those also consuming fluoridated water, depending on its calcium content. Fluoride applied topically as an ion the size of a water molecule penetrates gum tissue.

Fluoride and Adverse Teeth Health. All industrial ionic fluoride compounds lack calcium and are toxic calcium chelators. Teeth are harmed during chronic exposure to fluoride in at last five different ways.

1) Fluoride incorporates into dentin which is a derivative of bone, but a tissue that does not have turnover. Fluoride is thus permanent in dentin lifetime and, just as fluoride weakens bone, dentin is less resistant to cracking and fluoride in dentin is associated with teeth loss. The highest rate of teeth loss in the U.S. is in the state of Kentucky, the most completely fluoridated state in the U.S. The lowest incidence of teeth loss is in non-fluoridated Hawaii. The highest incidence of teeth loss in Europe is in silicofluoridated Southern Ireland. Fluoride can incorporate into dentin, either from that ingested into the bloodstream from water or pastes, or directly by passage through gum tissue from toothpaste topical use.

2) Fluoride from either the blood after ingestion, or from toothpaste applications, during enamelization of teeth in children can cause tooth fluorosis, where abnormal enamel hypoplasia occurs as a result of fluoride inhibition of enzymes necessary to remove albumin while minerals are deposited. The result is white spots of trapped albumin in the enamel where it does not belong and an ugly tooth. In some cases gross deterioration of the tooth can occur. If we examine pictures of victims of tooth fluorosis, caused by blood fluoride after ingesting fluoridated water during infancy, there can be destroyed areas of teeth, and even in more mild cases fluorosis is a permanent abnormality [National Research Council, Fluoride in Drinking Water, A Scientific Review of EPA’s Standards, D.C. 2006] that prevents a healthy normal smile [www.spotsonmyteeth.com (the Lillie Center].

The U.S. Oral Health Division. The CDC finally disputes that systemic fluoride fights teeth decay, but nevertheless puzzlingly still promotes fluoridation of water as a method to fight caries [U.S. CDC in: MMWR, Morbidity and Mortality Weekly Report, August 17,2001]. The argument has long been made that the teeth structure that remains in fluorotic victims is more resistant to decay because the hydroxyapatite normal enamel has been converted into an altered form [Newbrun, E., Fluorides and Dental Caries, Thomas Books, Springfield, ILL, 1972], but fluoride does not penetrate the enamel significantly, rather the ion can prevent the removal of albumin while teeth are depositing enamel during development, leading to loss of the translucent glass-like normal structure. Furthermore, locations where fluorotic teeth have worn away do not have cavities, because there is no teeth structure there. This bizarre argument was used to rationalize the lack of effect on decay rate in fluoridated Newburgh, where teeth erupted one year late due to systemic fluoride ingestion in the treated city [Connett, P., Micklem, Beck, The Case Against Fluoride, Chelsea Green Publishing, White River Junction, VT, 2011]. Decay rates were identical for both cities’ children after teeth grew into the mouth.

In other words, let’s consider that indeed fluoride in this severely fluorotic victim shown here has done its job in decreasing incidence of tooth decay (by virtue of spaces with no teeth regions that could contain cavities, and that remaining teeth surfaces have become ‘resistant’). The fact that teeth portions are ruined in a subset of the population from total fluoride exposure for all sources during development is considered of lesser importance because fluoride infusions into public water supplies are continued even though the incidence of dental fluorosis increases in all treated cities without exception. The fact that decay rates in teeth after growing into the mouth were identical in Newburgh is also not addressed in the OHD analysis.

3) Fluoride applied to teeth topically is sufficient of cause precipitation of calcium fluoride globules on the surface of teeth enamel. These are irregular porous globs that fill in pockets in enamel that are not smooth. Although some may argue this shields the tooth from caries, calcium fluoride is mostly and readily dissolved upon eating foods, and any trapped in teeth fissures for longer periods would be involved in beginning the formation of tartar. Tartar can trap bacteria unnaturally that cause caries, and does not preventing caries.

4) Small amounts of fluoride are argued to incorporate into surface enamel layers, a process called ‘remineralization’ of teeth. However, natural remineralization of enamel surfaces is known to occur with calcium and phosphate. Fluoride interferes with normal remineralization by producing an abnormal enamel surface. Enamel is normally extremely hard and fluoride cannot penetrate into the matrix of the enamel fortunately. Fluoride has been reported to be found in only the outer 2 micron layer (NRC, 2006, p.70).

5) In the case of fluoridation with fluorosilicic acid, an additional mechanism by which teeth are harmed over longterm exposure is by direct degradation. Fluorosilicic acid dissociates into fluoride ion and silicic acid in approximately equal amounts in trated water supplies. At neutral pH, the silicic acid as a very weak acid, is the intact molecule. At 0.6 ppm in water adjusted to 0.7 ppm fluoride, silicic acid explains well the leeching of lead from lead based plumbing in treated water supplies, and in agriculture silicic acid is a known disruptor of calcium phosphate, releasing free phosphate in soils for better uptake by plants. Drinking silicofluoridated water exposes calcium phosphate teeth enamel to the intact silicic acid at concentrations comparable to that for fluoride in the water. Longterm degradation cannot be avoided in the presence of this acid, much like it is known that enamel can be dissolved in carbonic acid in soda over long time periods.

Proper Teeth Care. It must be emphasized to those who hold the view, that ‘fluoridation is a great public health achievement’, that people who desire fewer teeth caries also prefer to retain their teeth, and to have a healthy normal smile, and to have normal translucent glasslike teeth enamel while cavities are being fought. Teeth decay can be fought by brushing after eating sugar, or avoiding sugar, and treatment of gums to inhibit cavity-causing Streptococcus mutans with regular teeth cleaning or now with laser therapy when necessary.

Fluoride in saliva at 0.02 ppm or in water at 0.7 ppm cannot penetrate teeth enamel with significance, nor decrease bacterial growth [Meiers, P., Fluoride and Dental Caries: Second Thoughts in View of Recent Evidence from Germany, Fluoride 44(1) pp. 1-6, 2011]. This is consistent with the lack of incorporation of fluoride into teeth enamel interiors when treated with 12,000 ppm fluoride, proven by detailed electron microscopic examination [Türkiye, et.al., 1993]. Toothpaste contains 1,500 ppm fluoride, a level that does not slow bacterial growth unless the medium were acidic, where sufficient corrosive HF could form.

CDC Unable to Explain Discrepancy. It has now been six months since asking the CDC to clarify why fluoride in saliva that bathes teeth topically at 0.02 ppm is 75,000 times less concentrated than in toothpaste (letter to FDA dated August 21, 2012). The CDC after two months responded that they have no answer to the inquiry and would send it to others to try to find an answer. No answer has been provided to date and I have been advised by legal counsel that it is therefore legal and proper to conclude that the CDC, in not providing a timely answer, does not have an answer. The Oral Health Division of the CDC has no legal right to authorize the infusion of industrial fluoride compounds into public water supplies at this useless concentration. Hence the FDA has been asked on behalf of the citizens of these United States to ban the practice of adding industrial fluorides into public water supplies to treat people for dental caries, when it has not been FDA approved for this purpose. The 1966 ban on fluorides intended for oral ingestion in pregnant women was ordered because of no evidence of effectiveness, and the requested ban on fluorides to be infused into water supplies to treat people is also for this same reason.

Fluoride Lack of Effect on Caries. Differences in the consumption of caries-causing sugar were not examined in the original anecdotal studies claiming caries benefit from ingested fluoride water that began this whole belief system that infusing industrial fluorides into water systems was necessary to ‘fortify’ water. The false hope that systemic fluoride ingested from water would affect enamel caries fell by the wayside when biochemical proof demonstrated that 1) systemic fluoride accumulates into dentin interiors of teeth (average 394 ppm from 1 ppm treated water) (National Research Council, Report on Fluoride in Drinking Water, 2006, p. 73) that enamel exists to protect (p. 126), and 2) fluoride in the bloodstream from consumed water, treated with industrial fluoride without FDA approval, causes, without exception in any treated city, increased incidence of inefficient enamel formation during teeth development, where ugly enamel fluorosis has reached endemic incidence in U.S. teens (http://www.cdc.gov/nchs/data/databriefs/db53.pdf). The U.S. Health and Human Services requested fluoride treatment of water supplies be reduced for merely this reason alone, and an official decision to ban the infusions is now necessary for the U.S. population, as was properly done in 1966 by the FDA for pregnant women.

Recent studies confirmed the concerns published by the National Research Council (2006, p. 126) regarding fluoridated dentin fracture and tooth loss (Offenbacher, et.al., Journal of Periodontal Research 27, p. 207, 1992). Because gum tissue and dentin incorporate fluoride both from toothpaste and from ingested water systemically, tooth loss and periodontitis are widely prevalent in the U.S. The state of Kentucky was presented an award by the American Dental Association for its mandatory fluoridation of virtually all public water supplies in the state for 50 years

(http://www.skagitcleanwater.com/Fluoridation_concern_%20Brief_%200utline.pdf). But no mention was made of the fact that tooth caries incidence in Kentucky is not lower than that in any other state (personal communication, Dr. Bill Osmunsen) and that the U.S. CDC published that Kentucky leads the nation in tooth loss at a massive 42% (Public Health and Aging: Retention of Natural Teeth Among Older Adults United States, 2002, Centers for Disease Control). There is no life-long reduction in dental decay that can be directly attributable to water fluoridation, and instead there appears to be an increase in tooth loss associated with fluoridation amongst the older population who have the longest exposure compared to non fluoridated communities (personal communication, Declan Waugh, Environmental Scientist, Ireland). The CDC report findings support this in noting:“The prevalence of edentate persons (i.e., those who have lost all their natural teeth) ranged from 13% in Hawaii to 42% in Kentucky.” The lowest rates of tooth loss in people over 60 years of age occur in the states with the lowest rates of water fluoridation. It is irrational to defend the idea that this is a coincidence, in light of the propensity of fluoride to concentrate into dentin as in skeletal bone, weakening bone.

U.S. Food and Drug Administration. The FDA ruled that fluoride is not a mineral nutrient and addition into water is an uncontrolled use of an unapproved drug. Further, the FDA in 1966 went so far as to ban the sale of industrial fluoride to infuse into drinking water intended to be ingested by pregnant women in the U.S. This ban was instituted because of proof that ingested fluoride by the mother does not decrease dental decay in the newborn after such exposure. Taking a drug that has no benefit is unethical, since all drugs, including fluoride, have adverse side effects.

On the other hand, FDA approved the use of fluoride in topical toothpastes but all are required to display the warning, “not to be swallowed or used by children under six.” Further, FDA approved the sale of bottled water if it happened to already contain fluoride as long as it is less or equal to 1 ppm and was not intentionally added into the water. Labeling of bottled waters for fluoride content were not permitted because FDA views fluoride as not being a normal or necessary ingredient in drinking water. Petitions have been filed with the FDA and accepted for review and remain pending, requesting that 1) all fluoride containing materials taken orally shall require a prescription, and 2) all industrial fluoride infusions into U.S. public water supplies be halted, as originally intended in the U.S.Water Pollution Control Act and the U.S. Safe Drinking Water Act (FDA-2007-P-0346).

I am so thrilled to see this effort. How can we be a part? I am furious about this issue. I am the first generation of this nonsense and believe the systemic injestion damaged my teeth lifelong. Based on theory that it would make our teeth stronger before eruption has been personally proven it didn’t. I worry about my grandchildren. This sounds like a perfect defense for the spouse trying to kill the other with small amounts of poison, well it’s only a small amount and we would both be better off if they were gone…..
Keep me posted!
JD Thomas 931-993-6497

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James Robert Deal is an attorney in Lynnwood, Washington. His practice focuses on mortgage modification and foreclosure defense. See www.Mortgage-Modification-Attorney.com. However, James is also an environmental attorney and has taken up the fight against adding toxic waste dental chemicals to drinking water. .

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